After Decades of Treatment-Resistant Depression, Here’s What Finally Helped Me

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My depression started at an early age, but living in a small town, there wasn’t a single therapist available for me to talk to. In fact, I didn’t receive any mental health support until I was in my late twenties. For a long time, I was able to cope by staying busy. The demands of my job distracted me and kept most of my symptoms at bay, but when I eventually stopped working, I couldn’t hide from my depression anymore. 

Once I began seeing my first psychiatrist in my thirties, he put me on my first antidepressant medication. It seemed to work OK… but any initial relief was short lived. So, I saw another psychiatrist. Then another one. Then another few. As I cycled through different psychiatrists trying to find the right fit, I was also trying one medication regimen after another—all without any success. It was so hard to find a provider that I could trust or someone who could actually identify what was going on with me. I felt as though the psychiatrists would hear me speak, but they weren’t actually listening to what I was saying or feeling. 

I remember one psychiatrist even told me, “Well, you look good. You dress well. You talk well. You’re educated. Maybe you should just get a job.” 

So here I was, at my wit’s end, and my only advice was to get a job. I was so taken aback by the assumption that I couldn’t be “that depressed” because I had gotten dressed for our appointment that day. What do you want me to do? I thought. Wear dirty clothes and not bathe for a week? 

Although it may not have seemed like it from the outside looking in, I was completely shutting down. At home, I put up triple black-out shades, curtains, and drapes on every window. I didn’t want to see the sun, and I definitely didn’t want to see anybody. I would lay barricaded in my room for hours and hours with my head hanging over the bed and my 18-inch TV on mute as my only source of light. To make a bad situation worse, I was also living with a toxic roommate at the time, and by spending all day in my room, I had inadvertently allowed him to take over my home. I did what I had to do to survive, but that was it—I was only surviving. 

It wasn’t until much later that I finally discovered there was a name for what I was experiencing. I was diagnosed with treatment-resistant depression or TRD, which is a type of depression that doesn’t respond adequately to two or more oral antidepressants.

The first time a therapist brought up trying SPRAVATO^® (esketamine) CIII nasal spray in addition to my oral antidepressant, I was too overwhelmed to even give it a try. She walked me through the risks and benefits and noted that some patients could experience suicidal ideation or be at risk to abuse or misuse the medication. She also said it would require going in twice a week for my appointments, but at the time, even taking on that much of a commitment was daunting. I was terrified to see people in general, let alone be in a doctor’s office for over two hours at each visit.

But after about a year of feeling this way, I knew something had to change. Nothing had gotten better, and someone on my mental health team once again brought up trying SPRAVATO^®. This time, I agreed. I was tired of living in darkness, tired of not being listened to, and tired of trying the same type of antidepressants over and over just to be disappointed again. I scheduled an appointment with a certified provider who shared more information and warned me about the most serious side effects such as sleepiness (sedation), fainting, dizziness, spinning sensation, anxiety, feeling disconnected from yourself, your thoughts, feelings, space and time (dissociation), breathing problems (respiratory depression and respiratory arrest), the risk of abuse and misuse, and increased risk of suicidal thoughts or actions. Then, as with all patients, I was enrolled in the SPRAVATO^® Risk Evaluation and Mitigation Strategy (REMS) Program to keep track of any serious side effects I may experience. (Please see Important Safety Information including BOXED WARNINGS and a list of side effects below. Click here.

So, I started my twice-weekly SPRAVATO^® treatments in conjunction with an oral antidepressant, and four weeks later, I could feel it kicking in. The black-out shades, curtains, and drapes were gone, and my new curtains have not been closed since. Of course, there are still days when I feel down. The main difference is, for the first time in my life, I’m able to start seeing my depressive symptoms improve. And, that improvement has allowed me to move forward with my life and get out of the house more. 

The progress I’ve made really hit home when my friend commented on how much I’ve changed. He said, “Jerry is back. You’ve been gone for so long, and it’s nice to see that you’re back.” I have no family and friends are few and far between, so to get a comment like this from someone who’s known me for over 20 years meant everything. 

When you’re depressed, it’s really easy to get taken advantage of—but now, I don’t allow it. While I’m never rude, I’ve been better at speaking my mind and expressing what I want. Instead of hanging my head low, I hold my head high. I’ve even carried this through to my mental health care to ensure that members of my care team are supportive of me and my treatment plan. For instance, when we talk, I expect them to look at me—not at the computer screen—because I am somebody. I am worthy and I don’t deserve to be neglected.

Of course, my story and my experience with SPRAVATO^® is my own, and similar to every treatment, this medication may not work for everyone. That’s why it’s important to be patient and have realistic expectations. Everyone’s depression is different, and you have to try and figure out what works best for you. 

Now, I have a therapist who actually listens to me, and I truly look forward to my SPRAVATO^®  treatments. The people who work at the treatment center have always been kind as they monitor me while I self-administer the medication and during the two hours that follow to check for adverse events and to make sure that my blood pressure is okay before I leave. And, when you see those same people routinely for two years, they really become more like family.

For people still stuck in the dark hole that is depression, I want you to know there are options. Don’t be afraid to educate yourself and to be your own advocate. If you feel like something isn’t working, repeat yourself as many times as you need to until someone finally listens. You deserve and are worthy of support. Sure, we’ll have “blue days” here and there, but with some help, we can move forward.

INDICATIONS

What is SPRAVATO^® (esketamine) CIII nasal spray?

SPRAVATO^® is a prescription medicine, used along with an antidepressant taken by mouth to treat:

• Adults with treatment-resistant depression (TRD)
• Depressive symptoms in adults with major depressive disorder (MDD) with suicidal thoughts or actions

SPRAVATO^® is not for use as a medicine to prevent or relieve pain (anesthetic). It is not known if SPRAVATO^® is safe or effective as an anesthetic medicine.

It is not known if SPRAVATO^® is safe and effective for use in preventing suicide or in reducing suicidal thoughts or actions. SPRAVATO^® is not for use in place of hospitalization if your healthcare provider determines that hospitalization is needed, even if improvement is experienced after the first dose of SPRAVATO^®.

It is not known if SPRAVATO^® is safe and effective in children.

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about SPRAVATO^®?
SPRAVATO^® can cause serious side effects, including:

• Sedation and dissociation. SPRAVATO^® may cause sleepiness (sedation), fainting, dizziness, spinning sensation, anxiety, or feeling disconnected from yourself, your thoughts, feelings, space and time (dissociation).
  • Tell your healthcare provider right away if you feel like you cannot stay awake or if you feel like you are going to pass out.
  • Your healthcare provider must monitor you for serious side effects for at least 2 hours after taking SPRAVATO^®. Your healthcare provider will decide when you are ready to leave the healthcare setting.

• Respiratory depression was observed with the use of SPRAVATO^®; additionally, there were rare reports of respiratory arrest.
  • Your healthcare provider must monitor you for serious side effects for at least 2 hours (including pulse oximetry) after taking SPRAVATO^®. Your healthcare provider will decide when you are ready to leave the healthcare setting.

• Abuse and misuse. There is a risk for abuse and physical and psychological dependence with SPRAVATO^® treatment. Your healthcare provider should check you for signs of abuse and dependence before and during treatment with SPRAVATO^®.
  • Tell your healthcare provider if you have ever abused or been dependent on alcohol,  prescription medicines, or street drugs.
  • Your healthcare provider can tell you more about the differences between physical and psychological dependence and drug addiction.

• SPRAVATO^® Risk Evaluation and Mitigation Strategy (REMS). Because of the risks for sedation, dissociation, respiratory depression, and abuse and misuse, SPRAVATO^® is only available through a restricted program called the SPRAVATO^® Risk Evaluation and Mitigation Strategy (REMS)  Program. SPRAVATO^® can only be administered at healthcare settings certified in the  SPRAVATO^® REMS Program. Patients treated in outpatient healthcare settings (e.g.,  medical offices and clinics) must be enrolled in the program.

• Increased risk of suicidal thoughts and actions. Antidepressant medicines may increase  suicidal thoughts and actions in some people 24 years of age and younger, especially within the first few months of treatment or when the dose is changed. SPRAVATO^® is not for use in children.
  • Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Some people may have a higher risk of having suicidal thoughts or actions. These include people who have (or have a family history of) depression or a history of suicidal thoughts or actions.

• How can I watch for and try to prevent suicidal thoughts and actions in myself or a  family member?
  • Pay close attention to any changes, especially sudden changes, in mood, behavior,  thoughts, or feelings, or if you develop suicidal thoughts or actions.
  • Tell your healthcare provider right away if you have any new or sudden changes  in mood, behavior, thoughts, or feelings.
  • Keep all follow-up visits with your healthcare provider as scheduled. Call your  healthcare provider between visits as needed, especially if you have concerns  about symptoms.

• Tell your healthcare provider right away if you or your family member have any of the  following symptoms, especially if they are new, worse, or worry you:

suicide attempts thoughts about suicide or dying

worsening depression other unusual changes in behavior or mood

Do not take SPRAVATO^® if you:

• have blood vessel (aneurysmal vascular) disease (including in the brain, chest, abdominal  aorta, arms and legs)
• have an abnormal connection between your veins and arteries (arteriovenous  malformation)
• have a history of bleeding in the brain
• are allergic to esketamine, ketamine, or any of the other ingredients in SPRAVATO^®.

If you are not sure if you have any of the above conditions, talk to your healthcare provider before taking SPRAVATO^®.   

Before you take SPRAVATO^®, tell your healthcare provider about all of your medical  conditions, including if you: 

• have heart or brain problems, including:
  • high blood pressure (hypertension)
  • slow or fast heartbeats that cause shortness of breath, chest pain, lightheadedness,  or fainting
  • history of heart attack
  • history of stroke
  • heart valve disease or heart failure
  • history of brain injury or any condition where there is increased pressure in the brain
• have liver problems
• have ever had a condition called “psychosis” (see, feel, or hear things that are not there, or believe in things that are not true).
• are pregnant or plan to become pregnant. SPRAVATO^® may harm your baby. You should not take SPRAVATO^® if you are pregnant.
  • Tell your healthcare provider right away if you become pregnant during treatment with SPRAVATO^®.
  • If you are able to become pregnant, talk to your healthcare provider about methods to prevent pregnancy during treatment with SPRAVATO^®.
  • There is a pregnancy registry for women who are exposed to SPRAVATO^® during pregnancy. The purpose of the registry is to collect information about the health of women exposed to SPRAVATO^® and their baby. If you become pregnant during treatment with SPRAVATO^®, talk to your healthcare provider about registering with the National Pregnancy Registry for Antidepressants at 1-844-405-6185 or online at  https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/antidepressants/.
• are breastfeeding or plan to breastfeed. You should not breastfeed during treatment with SPRAVATO^®.

Tell your healthcare provider about all the medicines that you take, including prescription and  over-the-counter medicines, vitamins and herbal supplements. Taking SPRAVATO^® with certain medicine may cause side effects. 

Especially tell your healthcare provider if you take central nervous system (CNS) depressants,  psychostimulants, or monoamine oxidase inhibitors (MAOIs) medicine. Keep a list of them to show to your healthcare provider and pharmacist when you get a new medicine. 

How will I take SPRAVATO^®? 

• You will take SPRAVATO^® nasal spray yourself, under the supervision of a healthcare provider in a healthcare setting. Your healthcare provider will show you how to use the  SPRAVATO^® nasal spray device.
• Your healthcare provider will tell you how much SPRAVATO^® you will take and when you will take it.
• Follow your SPRAVATO^® treatment schedule exactly as your healthcare provider tells you to.
• During and after each use of the SPRAVATO^® nasal spray device, you will be checked by a  healthcare provider who will decide when you are ready to leave the healthcare setting.
• You will need to plan for a caregiver or family member to drive you home after taking  SPRAVATO^®.
• If you miss a SPRAVATO^® treatment, your healthcare provider may change your dose and treatment schedule.
• Some people taking SPRAVATO^® get nausea and vomiting. You should not eat for at least 2  hours before taking SPRAVATO^® and not drink liquids
  at least 30 minutes before taking  SPRAVATO^®.
• If you take a nasal corticosteroid or nasal decongestant medicine take these medicines at least 1 hour before taking SPRAVATO^®.

What should I avoid while taking SPRAVATO^®? 

Do not drive, operate machinery, or do anything where you need to be completely alert after  taking SPRAVATO^®. Do not take part in these activities until the next day following a restful  sleep. See “What is the most important information I should know about SPRAVATO^®?” 

What are the possible side effects of SPRAVATO^®? 

SPRAVATO^® may cause serious side effects including: 

See “What is the most important information I should know about SPRAVATO^®?” 

Increased blood pressure.  SPRAVATO^® can cause a temporary increase in your blood pressure that may last for about 4 hours after taking a dose. Your healthcare provider will check your blood pressure before taking SPRAVATO^® and for at least 2 hours after you take SPRAVATO^®. Tell your healthcare provider right away if you get chest pain, shortness of breath, sudden severe headache, change in vision, or seizures after taking SPRAVATO^®.

Problems with thinking clearly. Tell your healthcare provider if you have problems thinking or remembering. 

Bladder problems. Tell your healthcare provider if you develop trouble urinating, such as a  frequent or urgent need to urinate, pain when urinating, or urinating frequently at night.  

The most common side effects of SPRAVATO^® when used along with an antidepressant taken  by mouth include: 

feeling disconnected from yourself, your thoughts, feelings and things around you  dizziness nausea feeling sleepy spinning sensation

decreased feeling of sensitivity (numbness) feeling anxious lack of energy increased blood pressure vomiting feeling drunk feeling very happy or excited

If these common side effects occur, they usually happen right after taking SPRAVATO^® and go away the same day. 

These are not all the possible side effects of SPRAVATO^®.  

Call your doctor for medical advice about side effects. You may report side effects to FDA at  1-800-FDA-1088. 

Please see full Prescribing Information, including Boxed WARNINGS, and Medication Guide for SPRAVATO^® and discuss any questions you may have with your healthcare provider. 

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For more information about SPRAVATO^®, please visit www.spravato.com.

This information is intended for the use of patients and caregivers in the United States and its territories only. Laws, regulatory requirements and medical practices for pharmaceutical products vary from country to country. The Prescribing Information included here may not be appropriate for use outside the United States and its territories.

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